Denise Matsuyama Lai, MA, CCLS, CIMI
Certified Child Life Specialist II
UCLA Mattel Children’s Hospital
Millicent Ongaco, MS, CCLS
Certified Child Life Specialist II
UCLA Mattel Children’s Hospital
The Association of Child Life Professionals has been using Zoom professionally for years. This platform has allowed child life specialists in our field to network and help our professional community. In this past year, many child life specialists have become proficient in using Zoom, not only for professional networking reasons but also to support children and families. Zoom is just one of many virtual platforms that have been allowing connections for both personal and professional reasons. For purposes of this article, we will be referring to any virtual platform as Zoom. There is so much to explore in the use of Zoom and the limitations that accompany using an electronic internet-based program. While we are not experts on the issues that accompany the limitations of Zoom, such as screen-time concerns, “zoom fatigue”, or internet access and connectivity, we do have expertise in working with children. In this article, we will review some child development-focused considerations for Zoom and explore the use of virtual platforms by our hospital-based child life team and other child life programs in the community.
Developmentally Appropriate Zoom Practices for Use by Child Life Professionals
In 2016, long before the pandemic, the American Academy of Pediatrics had revised their standings on the “no screen time” rule for children under the age of 2 years. While they continue to discourage screen time for children younger than 18 months, they do make an exception for live video chat (Council on Communications and Media, 2016). Whether or not the child on Zoom is a toddler, teen, or somewhere in between, there are a few things to consider when interacting with them on Zoom:
- Acknowledge and welcome the individuals (children/patients/family members) joining the Zoom. As child life professionals, we strive to initiate and maintain trusting and meaningful therapeutic relationships. By welcoming and connecting with each participant we are laying the building blocks to create a safe and trusting environment via Zoom.
- Be present and mindful of your interactions with the individuals (children/patients/family members) on Zoom. One of the main tenants of child life is being able to assess and identify the psychosocial needs of infants, children, youth, and families. In all interactions, including Zoom, we want to be present and mindful of our interactions; on-screen distractions may be more noticeable, so being respectful, kind, and open allows the child life specialist to create a safe environment for supportive care plans.
- Use self-talk (describe your actions) and parallel talk (describe the participants’ actions) during activities on Zoom. As child life professionals, we value facilitating communication in all forms to allow children and families to express their needs. Silence is sometimes needed for thinking space, but silence can also be stressful to a child who doesn’t know what to say. Self-talk and parallel talk can provide a soothing and inviting door to someone who doesn’t know what to say or do.
- Don’t focus on having video on for each participant. Allow control over having the camera on or off and let the child decide what they feel most comfortable with. In a personal discussion with a school counselor, they mentioned that they had advocated for a student to keep her camera off which led to increased self-esteem, and eventually the student turned on her camera with a big smile for the counselor who supported her decision. This is a perfect example of how child life professionals can advocate for the rights of the infant, child, youth, and family, which will lead to overall emotional safety and better coping.
- Encourage the child/teen to voice their wishes on how medical care is provided when they are utilizing Zoom for school, meetings, or other activities while in the hospital or outpatient clinic settings. Normalizing the hospital experience is an area in which child life professionals excel and encouraging the child/teen to speak with the medical team to come up with a comfortable plan will go a long way. A child may ask the nurse to position their line and IV pole away from the camera, allowing the RN access to it where the class can’t see, or a teen can time certain cares or therapy sessions around important class times. Work together, consider HIPAA, and compromise.
Innovative Zoom Practices in Hospitals
Since April 2020, the Chase Child Life and Creative Arts Therapy Department at UCLA Mattel Children’s Hospital has been using Zoom for group playroom sessions. The Zoom playroom sessions have allowed for our patients to connect through play. Our Zoom Playroom sessions are seven days a week with a few extra sessions for specific age groups (toddlers/preschoolers, teens, and parents). Each room is equipped with iPads, and the Child Life Department has iPads to loan out if a patient does not have access to a device. Each session is led by a child life specialist with the addition of volunteers who provide additional “voices” during the sessions. The volunteers can join the Zoom Playroom at home the same way the patients do in their individual hospital rooms. Our volunteers have found innovative ways of interacting with our patients from a distance – playing games, offering sewing lessons, creating a craft, doing a science project, and reading stories. One of our volunteers has been finding digital books, turning off the sound, and reading and interacting with the children while the animation of the book plays. Even patients in isolation can join the Zoom playroom sessions and interact with the child life team, volunteers, and other patients.
Zoom Playroom sessions have not been limited to the physical space of the playroom. These Zoom sessions allow for interaction and the ability to explore different environments – which can reach beyond what can be offered through other types of programming like CCTV. We have taken advantage of visiting places the pediatric patients typically do not have the opportunity to visit. Some of our volunteers have shared their home gardens with the patients. Our community partners that normally come and provide programming in the hospital and outpatient areas have even joined forces with us leading magic shows, safari tours, movie viewings, and other fun activities. Our People Animal Connection program has brought the experience of playing ball with dogs in their backyards to the patients in the hospital. We even visited the hospital kitchen to find out where a patient’s meal comes from. The music therapy team has been using Zoom to host not only music therapy programming but also a Virtual Coffee House which allows the team to bring in musical artists from throughout the US. There are many activities available through Zoom such as virtual field trips, digital books, and online games and much more – most of these activities can be found through simple internet searches. As we slowly return to normal, many of the Zoom Playroom interactions have allowed us to think about incorporating these aspects in our programming alongside in-person group activities as it becomes safe to return to “normal” operations.
We have also utilized the Zoom platform to further our services and connections to families outside of the hospital setting. As visitor restrictions were tightened and only one caregiver and no siblings were allowed to visit, specialists set up sessions to continue therapeutic interventions and teachings to further support the patient and family during crisis. This has been a vital way for specialists to continue providing services and for families to feel supported and heard.
Volunteers are also a crucial part of our Child Life Program. Coming in weekly and interacting with the patients in the Playroom or at bedside is an important part of their lives. Seeing how much of an impact not being able to volunteer due to visitor/staff restrictions and closure of Playrooms, our program used Zoom to connect with volunteers to check-in and strengthen the child life specialist and volunteer relationship during the pandemic. Some volunteers have taken it a step further and have coordinated Zoom sessions between themselves without child life involvement to help with their own coping.
Innovative Zoom Practices in the Community
Wonders and Worries, a community-based child life program that provides support to children of adult patients, also began providing support to the families they serve through virtual programming during the pandemic. Crystal Wilkins from Wonders and Worries shared, “We did have to adjust our curriculum to effectively meet the needs of the families we served. Thankfully, being a team of child life specialists, we are especially gifted at creativity and flexibility.” These skills enabled the team at Wonders and Worries to transition to a virtual platform in a matter of weeks to continue to serve the children and families during the pandemic.
Allison Moore is the Child Life Program Supervisor for Children’s Comprehensive Care, located in central Texas. Allison provided child life services via Zoom for the program, to meet with patients and their siblings as well as children of adult patients during the pandemic. She said virtual platforms such as Zoom “has allowed me to reach more children than I was able to pre-pandemic due to circumstances that would otherwise prevent patients and families from coming to our clinic in-person. For example, distance, transportation challenges, weakened immune systems, and technology dependence.” Although she can’t wait to meet with her patients in-person again, Zoom has allowed for therapeutic relationships with the children with whom she works.
Zoom: A Tool with Expanding Potential
This past year has challenged us as child life professionals in ways we could never imagine. Our adaptability, flexibility, and creativity, the building blocks of our child life skills, have been put to the test and pushed us to continue providing education, support, and play during a crucial time. Zoom and other virtual platforms gave us the opportunity to continue our work in the hospital and communities we serve and have even presented some new and exciting possibilities for service. These tools have given us continued life during a time when in-person connection was not allowed. Nothing can replace in-person interactions or play, but until the time comes when we can safely gather, virtual platforms such as Zoom are allowing us to maintain and even expand our work.
Council on Communications and Media - American Academy of Pediatrics. (2016) Media and young minds. Pediatrics Vol 138(5).https://doi.org/10.1542/peds.2016-2591.
Moore, A. (2021, March 24). Personal Communication [Email Interview]
Wilkins, C. (2021, March 15). Personal Communication for Wonders and Worries [Email Interview]